Antibiotics for Both Moderate and Severe Cholera

Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
New England Journal of Medicine (Impact Factor: 55.87). 01/2011; 364(1):5-7. DOI: 10.1056/NEJMp1013771
Source: PubMed
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    • "Antibiotics are not obligatory to successfully treat patients, but they can reduce the duration of disease, diminish the volume of rehydration fluids needed, as well as reduces the duration of shedding of the pathogen. Different classes of antibiotics such as doxycycline, ciprofloxacin and azithromycin are effective in the treatment of cholera in treating V. cholerae infection (Nelson et al., 2011). Fluoroquinolone drugs are commonly used in the treatment of enteric infections, because of their good in vitro activity, the high serum and stool concentrations achieved after ingestion, and their safety (DuPont et al., 1993). "
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    ABSTRACT: In this study, we have established an oral phage cocktail therapy in adult mice model and also performed a comparative analysis between phage cocktail, antibiotic and oral rehydration treatment for orally developed Vibrio cholerae infection. Four groups of mice were orally infected with Vibrio cholerae MAK 757 strain. Phage cocktail and antibiotic treated groups received 1 × 108 plaque forming unit/ml (once a daily) and 40 mg/kg (once a daily) as an oral dose respectively for consecutive three days after bacterial infection. In case of oral rehydration group, the solution was supplied after bacterial infection mixed with the drinking water. To evaluate the better and safer approach of treatment, tissue and serum samples were collected. Here, phage cocktail treated mice reduced the log10 numbers of colony per gram by 3 log10 (p < 0.05); however, ciprofloxacin treated mice reduced the viable numbers upto 5 log10 (p < 0.05). Whereas, the oral rehydration solution application was not able to reduce the viable bacterial count but the disease progress was much more diminished (p > 0.05).Besides, it was evident that antibiotic and phage cocktail treated group had a gradual decrease in both IL-6 and TNF-α level for 3 days (P < 0.05) but the scenario was totally opposite in bacterial control and oral hydration treated group. Histological examinations also endorsed the phage cocktail and ciprofloxacin treatment in mice. Although, in this murine model of cholera ciprofloxacin was found to be a better antimicrobial agent, but from the safety and specificity point of view, a better method of application could fill the bridge and advances the phages as a valuable agent in treating Vibrio cholerae infection.
    International journal of medical microbiology: IJMM 05/2014; 304(3). DOI:10.1016/j.ijmm.2014.02.007 · 3.61 Impact Factor
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    • "The World Health Organization (WHO) recommends rehydration as the mainstay of therapy for Cholera, antimicrobial therapy is advocated only in the management of severe cases-mostly interpreted as cases with “severe dehydration”; to reduce the severity of illness, shorten the duration of diarrhea and to reduce the duration of fecal excretion [7]. While the recommendations of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) do not restrict use of antibiotics to only “severe” cases and children with “some dehydration” who continue to pass large volumes of stool, are also candidates for antibiotic therapy [8,9]. "
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    ABSTRACT: Diarrhea is a major contributor to the burden of morbidity and mortality in children; it accounts for a median of 11% of all deaths among children aged less than 5 years, amounting to approximately 0.8 million deaths per year. Currently there is a dearth of literature exploring the effectiveness of antibiotics for diarrhea due to Cholera, Shigella and cryptosporidiosis in children. We reviewed the literature reporting the effect of antibiotics for the treatment of diarrhea due to Cholera, Shigella and Cryptosporidium in children under five years. We used a standardized abstraction and grading format and performed meta-analyses to determine the effect of the treatment with various antibiotics on mortality and rates of clinical and bacteriological/parasitological failure. The CHERG Standard Rules were applied to determine the final effect of treatment with antibiotics on diarrhea morbidity and mortality. For Cholera; the evidence was weak to recommend any effect on mortality. For Shigella; there was no data on mortality; either all-cause or cause specific, hence we used clinical failure rates as a proxy for Shigella deaths and propose that treatment of Shigella dysentery with antibiotics can result in a 82% reduction in diarrhea mortality due to Shigella. For cryptosporidiosis; there was data on all-cause mortality but the evidence was weak hence we used clinical failure rates as a proxy for mortality to estimate that antimicrobial treatment of diarrhea due to cryptosporidiosis can result in a 54% reduction in mortality. There is evidence to recommend antibiotic use for reduction of morbidity and mortality due to Cholera, Shigella and Cryptosporidium. We recommend that more clinical trials should be conducted to evaluate the efficacy and safety of first- and second- line drugs currently in use for treatment for diarrhea and dysentery in both developing and developed countries.
    BMC Public Health 09/2013; 13 Suppl 3(Suppl 3):S10. DOI:10.1186/1471-2458-13-S3-S10 · 2.26 Impact Factor
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    • "Cholera infections can be effectively treated with oral rehydration and, in cases of severe illness, with antibiotics. Antibiotic treatment lessens the duration of illness and reduces the excretion of highly infective Vibrios (Nelson et al., 2011). The downside however, is the emergence of multiple-antibiotic resistant O1 and O139 strains (Das & Kaur, 2008; Roychowdhury et al., 2008; Okeke et al., 2007; Mwansa et al., 2007; Faruque et al., 2007). "
    Cholera, 03/2012; , ISBN: 978-953-51-0415-5
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